JAMA Surgery: Medical Practice Topic Collection

The Employed Surgeon A Changing Professional Paradigm The Employed Surgeon

Charles AG, Ortiz-Pujols S, Ricketts T, et al. — Mon, 01 Apr 2013 00:00:00 GMT

Objective

To identify trends and characteristics of surgeon employment in the United States. Surgeons are increasingly choosing hospital or large group employment as their practice environment.

Design

American Medical Association Physician Masterfile data were analyzed for the years 2001 to 2009.

Setting

Surgeons identified within the American Medical Association Masterfile.

Participants

Surgeons were defined using definitions from the American Medical Association specialty data and the American Board of Medical Specialties certification data and included active, nonfederal, and nonresident physicians younger than 80 years of age.

Main Outcome Measures

Employment status and trends.

Results

The number of surgeons who reported having their own self-employed practice decreased from 48% to 33% between 2001 and 2009, and this decrease corresponded with an increase in the number of employed surgeons. Sixty-eight percent of surgeons in the United States now self-identify their practice environment as employed. Between 2006 and 2011, there was a 32% increase in the number of surgeon in a full-time hospital employment arrangement. Younger surgeons and female surgeons increasingly favor employment in large group practices. Employment trends were similar for both urban and rural practices.

Conclusions

General surgeons and surgical subspecialists are choosing hospital employment instead of independent practice. The trend is especially notable among younger surgeons and among female surgeons. The trend denotes a professional paradigm shift of major importance.

Surgeons as Hospital Employees Comment on “The Employed Surgeon” Surgeons as Hospital Employees

Napolitano LM. — Mon, 01 Apr 2013 00:00:00 GMT

Over the past decade, there has been an explosive growth in hospital medicine with regard to hospital-based employment of hospitalists, and now surgeons are following in the footsteps of the hospitalists. Overall, data from the American Hospital Association indicate that hospitals currently employ about 25% of all active physicians. This increase mirrors the increase in the use of hospitalists from 2003 (30%) to 2010 (60%). The significant increase in the number of hospital-employed surgeons is paralleling this increase in the number of hospital-employed medical physicians. Throughout the United States, hospitals are increasingly implementing programs in which a core group of employed surgeons provide dedicated on-site services.

Patient Satisfaction as a Possible Indicator of Quality Surgical Care Patient Satisfaction and Quality of Surgical Care

Lyu H, Wick EC, Housman M, et al. — Mon, 01 Apr 2013 00:00:00 GMT

Importance

In 2010, national payers announced they would begin using patient satisfaction scores to adjust reimbursements for surgical care.

Objective

To determine whether patient satisfaction is independent from surgical process measures and hospital safety.

Design

We compared the performance of hospitals that participated in the Patient Satisfaction Survey, the Centers for Medicare & Medicaid Services Surgical Care Improvement Program, and the employee Safety Attitudes Questionnaire.

Setting

Thirty-one US hospitals.

Participants

Patients and hospital employees.

Interventions

There were no interventions for this study.

Main Outcomes and Measures

Hospital patient satisfaction scores were compared with hospital Surgical Care Improvement Program compliance and hospital employee safety attitudes (safety culture) scores during a 2-year period (2009-2010). Secondary outcomes were individual domains of the safety culture survey.

Results

Patient satisfaction was not associated with performance on process measures (antibiotic prophylaxis, R = −0.216 [P = .24]; appropriate hair removal, R = −0.012 [P = .95]; Foley catheter removal, R = −0.089 [P = .63]; deep vein thrombosis prophylaxis, R = 0.101 [P = .59]). In addition, patient satisfaction was not associated with a hospital's overall safety culture score (R = 0.295 [P = .11]). We found no association between patient satisfaction and the individual culture domains of job satisfaction (R = 0.327 [P = .07]), working conditions (R = 0.191 [P = .30]), or perceptions of management (R = 0.223 [P = .23]); however, patient satisfaction was associated with the individual culture domains of employee teamwork climate (R = 0.439 [P = .01]), safety climate (R = 0.395 [P = .03]), and stress recognition (R = −0.462 [P = .008]).

Conclusions and Relevance

Patient satisfaction was independent of hospital compliance with surgical processes of quality care and with overall hospital employee safety culture, although a few individual domains of culture were associated. Patient satisfaction may provide information about a hospital's ability to provide good service as a part of the patient experience; however, further study is needed before it is applied widely to surgeons as a quality indicator.